Hemovigilance Module Monthly Incident Summary - NHSN

Form Template

The Hemovigilance Module Monthly Incident Summary is required only if the facility chooses to report incidents using the summary option.

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When reporting using the summary option, detailed incident reports must also be completed for all high-priority incidents that occur and for incidents that are associated with a transfusion-associated adverse reaction. When completing this form, ALL incidents that occur should be counted, including those for which a detailed report is also entered. Monthly Incident Summaries should be entered within 30 days of the end of each month.

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